Patient Account Specialist - Revenue Cycle HB Billing & Denials

Location: TX-Galveston

Job Description:

Minimum Qualifications: High School Diploma or equivalent. Two years of financial experience or one year of patient accounts experience.

Licenses, Registrations, or Certifications: High School Diploma or equivalent.

Job Summary/Description: The Patient Account Specialist will be responsible for billing all third party payers through a claims processing vendor and/or for appeal of denied professional and/or hospital claims. Identifies billing issues affecting hospital and/or physicians claims/accounts and takes necessary action to ensure timely and appropriate claim filing. Performs follow-up activities and identifies reimbursement issues affecting these claims. Takes necessary actions to insure timely and appropriate reimbursement and account resolution.

Job Duties:

Demonstrates a level of competence and understanding of all state and federal laws, rules and regulations regarding payer billing guidelines
Demonstrates a basic understanding of CPT, ICD-9, HCPCS, modifier coding as well as POS requirements
Billing payers and/or clients for hospital and/or Professional Patient Accounts
Resolves Payer rejections from billing system daily to bill submit hospital and/or physicians claims
Performs online corrections to edited claims according to procedures
Performs detailed follow-up activities on assigned accounts according to procedures
Responds to daily correspondence according to procedures
Identifies denials and underpayments for appeal
Reviews, researches and processes denied claims
Appeal claims as appropriate according to policies and procedures
Updates account information and documents as appropriate within Epic Resolute
Processes account adjustments according to policies/procedures
Issues payer and/or patient refunds according to policies/procedures
Validates accuracy of payments and/or adjustments on accounts
Resolves outstanding accounts at required accuracy and productivity requirements
Maintains comprehensive knowledge of the work unit assigned
Assists in the development of department policies and procedures
Adheres to established policies and procedures
Adheres to internal controls and reporting structure
Maintains open and professional communication with customers, colleagues and vendors
Performs well in a team environment
Successfully completes competency based training and testing
Prioritizes and completes all work in an accurate, effective and efficient manner
Assists in the training and mentoring of new employees
Reads all announcements and relevant communications relating to job duties
Performs related duties as required.
Participates in team meetings/activities and supports the philosophy and goals of the team and department

Salary Range: Actual salary commensurate with experience or range if discussed and approved by hiring authority.

Work Schedule: Partial remote, onsite position as needed position must be a Texas resident. 8am to 5pm, and as needed on occasion.

Equal Employment Opportunity

UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a VEVRAA Federal Contractor, UTMB Health takes affirmative action to hire and advance women, minorities, protected veterans and individuals with disabilities.

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